The basic principles of successful wound closure remain the same: careful preoperative evaluation, removal of underlying nonviable tissue, and well-vascularized soft-tissue coverage. Many complex or "hostile" back wound closures also require stabilization of the spine and a two-layered wound closure. The use of long arteriovenous fistulas with free tissue transfer provides an additional weapon for the treatment of these complex wounds.
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Few et al. (2000) studied this question.
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